Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis

Marcus Povitz; Carmelle E Bolo; Steven J Heitman; Willis H Tsai; JianLi Wang; Matthew T James

doi:10.1371/journal.pmed.1001762

Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis

PLoS Med. 2014 Nov 25;11(11):e1001762. doi: 10.1371/journal.pmed.1001762. eCollection 2014 Nov.

Authors

Marcus Povitz¹, Carmelle E Bolo², Steven J Heitman³, Willis H Tsai³, JianLi Wang⁴, Matthew T James³

Affiliations

¹ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Western University, London, Ontario, Canada.
² Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
³ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.

Abstract

Background: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality, and decreased quality of life. Treatment with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is effective for many symptoms of OSA. However, it remains controversial whether treatment with CPAP or MAD also improves depressive symptoms.

Methods and findings: We performed a systematic review and meta-analysis of randomized controlled trials that examined the effect of CPAP or MADs on depressive symptoms in patients with OSA. We searched Medline, EMBASE, the Cochrane Central Registry of Controlled Trials, and PsycINFO from the inception of the databases until August 15, 2014, for relevant articles. In a random effects meta-analysis of 19 identified trials, CPAP treatment resulted in an improvement in depressive symptoms compared to control, but with significant heterogeneity between trials (Q statistic, p<0.001; I(2) = 71.3%, 95% CI: 54%, 82%). CPAP treatment resulted in significantly greater improvement in depressive symptoms in the two trials with a higher burden of depression at baseline (meta-regression, p<0.001). The pooled standardized mean difference (SMD) in depressive symptoms with CPAP treatment in these two trial populations with baseline depression was 2.004 (95% CI: 1.387, 2.621), compared to 0.197 (95% CI: 0.059, 0.334) for 15 trials of populations without depression at baseline. Pooled estimates of the treatment effect of CPAP were greater in parallel arm trials than in crossover trials (meta-regression, p = 0.076). Random effects meta-analysis of five trials of MADs showed a significant improvement in depressive symptoms with MADs versus controls: SMD = 0.214 (95% CI: 0.026, 0.401) without significant heterogeneity (I(2) = 0%, 95% CI: 0%, 79%). Studies were limited by the use of depressive symptom scales that have not been validated specifically in people with OSA.

Conclusions: CPAP and MADs may be useful components of treatment of depressive symptoms in individuals with OSA and depression. The efficacy of CPAP and MADs compared to standard therapies for depression is unknown. Please see later in the article for the Editors' Summary.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Continuous Positive Airway Pressure*
Depression / complications
Depression / therapy*
Humans
Mandibular Advancement*
Quality of Life
Sleep Apnea, Obstructive / complications
Sleep Apnea, Obstructive / therapy*

Grants and funding

SJ Heitman is supported by an award from the N.B. Hershfield Professorship in Therapeutic Endoscopy. M Povitz is supported by an award from the Western Regional Training Centre for Health Services Research. The authors received no specific funding for this work.